Dental services are covered as an optional medical service for New Mexico Medicaid recipients. Dental services include specific diagnostics, preventive, or corrective procedures to the teeth.
Requests for dental services must be accompanied by the appropriate documentation and clinical material, such as x-rays, charting, and study models for orthodontia. Make requests on the ADA form (appropriate ADA codes and tooth numbers/quadrants must be indicated). All requests are reviewed by peer consultants (i.e., dentists and/or orthodontists).
Quick Processing of Dental Review Requests
Each day, a large number of dental requests for authorization are received by the NMMUR department. Many of these are returned to the provider for more information as the result of an incomplete ADA form or missing supporting documentation.
The most common reasons a request is returned are:
• No subscriber ID number
• No date of birth
• No Provider ID number
• Missing teeth not charted on the ADA form
• Required documentation (x-rays, period charting, etc.) not submitted
• Non-diagnostic x-rays
Please take the time to look over your ADA form before submitting. Also, please look at x-rays being submitted. If they are blurry, too light or too dark, the reviewer will not be able to read them.
By making a few simple checks before you submit a request, you can ensure the process will go smoothly and you will receive your notification promptly.
Instructions for orthodontic treatment
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